Hypophysitis: An update on the novel forms, diagnosis and management of disorders of pituitary inflammation

Gubbi, Sriram; Hannah‐Shmouni, Fady; Verbalis, Joseph G.; Koch, Christian A.

doi:10.1016/j.beem.2019.101371

Cited by 86 publications

(152 citation statements)

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“…PH classification is also still evolving since some consider PH variants to be truly distinct entities or idiopathic forms, whereas others consider them to be a different expression of the same autoimmune process due to the possible occurrence of mixed forms [6]. SH is caused by a variety of inflammatory, infectious, vascular, and neoplastic conditions or as an adverse effect of various medications.…”

Section: Resultsmentioning

confidence: 99%

“…NH is the rarest form of PH (0.6%), with a female/male ratio of 3:1, of unknown etiology that can occur as SH or ICI-induced hypophysitis [6, 16, 17].…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…Mixed forms of hypophysitis are observed in 4% of PH cases [6]. Lymphogranulomatous hypophysitis may include features of LH and GH, but most likely presents a transition from an initial lymphocytic infiltrative pattern of LH to a more granulomatous, chronic inflammatory pattern [6]. Xanthogranulomatous hypophysitis contains both foamy xanthoma cells and multinucleated giant cells with cholesterol clefts and hemosiderin deposits [6].…”

Section: Resultsmentioning

confidence: 99%

“…Lymphogranulomatous hypophysitis may include features of LH and GH, but most likely presents a transition from an initial lymphocytic infiltrative pattern of LH to a more granulomatous, chronic inflammatory pattern [6]. Xanthogranulomatous hypophysitis contains both foamy xanthoma cells and multinucleated giant cells with cholesterol clefts and hemosiderin deposits [6]. XH is the earlier manifestation, followed by xanthogranulomatous hypophysitis changes that occur later during the course of the disease [13].…”

Section: Resultsmentioning

confidence: 99%

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Hypophysitis (Including IgG4 and Immunotherapy)

et al. 2020

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Hypophysitis is characterized by inflammation of the pituitary gland that can be primary (PH) or secondary (SH) to other diseases or following drug administration. It may also be classified according to anatomical and histopathological criteria, leading to variable degrees of hypopituitarism and/or compressive symptoms to nearby structures. There has recently been an increase in the number of hypophysitis cases, raising the interest on the spectrum of its pathogenesis, clinical, biochemical/endocrinological, and imaging features. However, the use of conventional biomarkers, including currently utilized pituitary autoantibodies, has relatively limited diagnostic accuracy. Lymphocytic hypophysitis (LH) is the commonest cause of PH, whereas IgG4-related hypophysitis is increasingly being recognized. Histiocytosis and granulomatous diseases are the most frequent causes of SH, although infections and lymphoma have also been reported. The increasing use of immune checkpoint inhibitors in oncology is associated with a high incidence of hypophysitis, providing further understanding of its pathogenesis. Hy-pophysitis can occur silently and be easily missed, potentially leading to substantial morbidity or mortality due to adrenal insufficiency, requiring a high index of clinical suspicion and timely initiation of appropriate treatment. In most cases of LH or drug-induced hypophysitis, active surveillance along with replacement of established hormonal deficiencies is needed. In the presence of compressive and/or evolving symptoms, treatment with glucocorticoids either alone or in combination with other immunosuppressive agents can be used. Surgical decompression is reserved for nonresponsive cases with threatened vital structures. Timely diagnosis and intervention are important to minimize disease-related morbidity and mortality. We aimed to review current concepts and recent developments in the pathogenesis, diagnosis, and management of hypophysitis.

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Section: Resultsmentioning

confidence: 99%

“…NH is the rarest form of PH (0.6%), with a female/male ratio of 3:1, of unknown etiology that can occur as SH or ICI-induced hypophysitis [6, 16, 17].…”

Section: Resultsmentioning

confidence: 99%